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Don't Rely Too Much on Doctor and Hospital Ratings
Tweet Share on Facebook November 4, 2010 CommentAt a recent conference, Harvard surgeon and best-selling author Atul Gawande told the audience of health professionals and policy makers that he always assigns his medical students a book about baseball called Moneyball: The Art of Winning an Unfair Game. It's the story of how the 2002 Oakland Athletics, which had one of the lowest payrolls in professional baseball, were able to consistently out-compete better financed teams due to their general manager's unrivaled ability to evaluate and appropriately value players. Oakland took advantage of the tendency of other teams to overvalue players based on word-of-mouth assessments of talent or commonly measured statistics—such as batting averages and number of stolen bases—that had little relationship to winning games.
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Home Blood Pressure Monitoring Works Better Than Doctor's
Tweet Share on Facebook October 28, 2010 Comment (1)Several years ago, I cared for an elderly woman with heart failure, diabetes, and high blood pressure who had at least one major health problem at every office visit. I'd get her blood sugar levels under control only to find that her blood pressure had risen dangerously. I'd adjust blood pressure medications only to find her short of breath with swollen legs—a sign of worsening heart failure—at her follow-up appointment. The trouble was, I had no idea how well she followed my instructions in between visits which occurred every month or two. Had her blood pressure been soaring at home for the past few weeks or only during the hour she was in my office? I had no way of knowing.
[10 Salt Shockers That Could Make Hypertension Worse]
Family physicians often have a tough time monitoring chronic health conditions, which leads to poor management of those conditions. Only half of the 65 million Americans with hypertension have achieved good control, according to a recent commentary in the American Journal of Managed Care. And it's not hard to understand why: A patient's blood pressure at an office visit may not be an accurate reflection of what the reading typically is at home; in fact, it's often much higher, leading doctors to coin the term "white coat hypertension." Knowing this, doctors are often reluctant to increase medication doses or add new medications; we're afraid of lowering blood pressure too much, which can make patients lightheaded and cause them to stop taking their medications altogether.
[Slideshow: 5 Questions to Ask Before You Fill That Prescription]
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New Electronic Medical Records Software Could Improve Your Health
Tweet Share on Facebook October 13, 2010 Comment (4)For most of my career as a family doctor, I kept track of my patients' health histories by scribbling hand-written notes in a paper chart. For a healthy child, I'd include dates when vaccines were given; for an adult with, say, diabetes, I'd make sure to jot down a recommended schedule of blood and urine tests as well as foot and eye exams. A majority of primary care physicians, in fact, still use this kind of tracking system—despite research suggesting that these handwritten flowsheets aren't just inefficient, but extremely vulnerable to errors. Some say the solution lies in simply switching to electronic medical records.
[6 Ways Electronic Medical Records Could Make Your Life Safer and Easier]
After all, paper charts don't automatically update themselves when, say, the Centers for Disease Control and Prevention makes a new vaccine recommendation. An electronic medical record system can do that and can also allow test results to be emailed or transferred automatically into a patient's chart; paper charts rely on office administrators to input them by hand, which can lead to mistakes. I, myself, have occasionally forgotten to record that a vaccine was administered during the chaos of a busy work day. Nor did I have any systematic way of knowing how many of my patients were actually receiving the preventive and chronic care they needed.
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Thinking of Trying a Low-Carb Diet Plan? 3 Things to Consider
Tweet Share on Facebook September 28, 2010 Comment (6)I first heard of the Atkins diet back in medical school 12 years ago when one of my classmates abruptly began eating steak without potatoes and hamburgers without the bun. I was skeptical that this odd regimen would work, but his experience and subsequent research has shown that low-carbohydrate diets are as effective as traditional low-calorie, low-fat diets for losing weight.
[Weighing the Evidence of 6 Popular Diet Programs]
A more important question is whether a low-carbohydrate diet, which includes higher amounts of protein and fat than the typical higher-carb diet, is as good for your heart in the long run. Two recent studies published in the journal Annals of Internal Medicine seem to provide conflicting answers. In the first study, researchers randomly assigned 307 overweight adults to a low-carbohydrate or a low-fat diet, in addition to exercise counseling. After 2 years, participants in both groups had lost an average of about 15 pounds, but the low-carbohydrate group had a significantly greater increase in HDL "good" cholesterol.
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Heart Failure Treatment: Counseling Not Necessary
Tweet Share on Facebook September 21, 2010 Comment (1)Heart failure is the most common reason seniors wind up in the hospital, and many patients are hospitalized again and again. They find it's just too difficult to properly manage their condition with its complex drug regimens, dietary restrictions, and frequent monitoring—all of which have been shown in studies to reduce their risk of severe disability and even death. As a family doctor, I've always had a hard time getting my patients to adhere to my advice on managing their heart failure and assumed that any additional one-on-one counseling would be beneficial. Turns out, though, that may not be the case. A study published in today's issue of the Journal of the American Medical Association finds that patients with heart failure who receive customized support are no less likely to suffer from disabling symptoms, be hospitalized, or die prematurely than patients receiving standard educational materials.
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Drug Discount: 5 Ways to Save at the Pharmacy
Tweet Share on Facebook September 8, 2010 Comment (4)With our nation still mired in a deep recession, many of us are having a tough time paying for prescription drugs—especially those for chronic conditions like heart disease and diabetes. In fact, a Consumer Reports survey last year found that 28 percent of Americans have taken drastic steps to cut costs, like not filling their prescriptions, skipping dosages, and cutting pills in half without getting their doctor's OK. There are, however, far safer approaches for saving money on prescription medications. Try these five strategies.
1. Don't assume new drugs are superior. Prescription drugs aren't like software and cellphones. Newer versions aren't necessarily better and may occasionally be inferior to older and less expensive pills. While prescription Clarinex for seasonal allergies is more expensive than over-the-counter Claritin, studies suggest it's no more effective. And prescription Nexium is certainly a pricey way to treat acid reflux when most heartburn sufferers can get substantial relief from cheaper, generic omeprazole. I also remember how excited doctors were about Vioxx for arthritis pain; we quickly switched patients away from ibuprofen, since Vioxx was thought to be easier on the stomach, but later regretted it when Vioxx was withdrawn from the market after being linked to heart attacks and strokes.
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Multiple Health Problems? Try Care Management
Tweet Share on Facebook August 17, 2010 CommentWhen my three-year old son began having recurrent coughing fits and shortness of breath after exercise, my wife and I knew the probable diagnosis. She and I are both doctors, and my wife has asthma. We made an appointment with our family doctor who confirmed that our son, indeed, had asthma. After prescribing medications to prevent and manage the symptoms, our doctor would have—had we not been medical professionals—taken just 10 or 15 minutes to explain how to administer the medications and avoid triggers like tobacco smoke, mold, pollen, and hairy pets. She would have also had to cram in lessons on recognizing the early warning signs of an asthma attack, what actions to take to treat it, and when to call the office or go straight to the emergency room.
Our son's doctor didn't have go into detail about any of those things and, given her crowded waiting room, I suspect she was grateful. But what about the 7 million other parents whose children are diagnosed with asthma? Or those who live with chronic conditions like diabetes and heart disease who don't have the benefit of my medical school training? Even seeing your doctor several times a year isn't enough to keep you well versed on keeping your disease under control. That's a major reason why so many with diabetes and heart failure wind up in the hospital again and again with complications related to their condition.
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3 Ways to Get Your Doctor to Take Your Pain Seriously
Tweet Share on Facebook August 10, 2010 Comment (5)During my eight years seeing patients as a family physician, I've found that their individual health beliefs often played a big role in important decisions such as starting a new medication or undergoing an invasive test or procedure. Some patients were more willing to endure potentially risky procedures in order to learn their diagnosis quicker, for example, while others preferred "watchful waiting," or monitoring symptoms that were unlikely to be a sign of anything serious. Unfortunately, in a typical 15-minute office visit, I barely had enough time to establish a friendly rapport with my patients, much less probe them deeply about their beliefs. As a result, I'd often find myself making assumptions about the care they preferred.
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